Young Epidemiology Scholar National Finalist Scott Kobner, 2008

August 27, 2012

"Both of my parents are police officers so I didn't really have a huge exposure to medicine or public health, Scott Kobner says of his years growing up in New Jersey. He did, however, have an aunt who was a hospital nurse and would on occasion let him visit her at work and observe. That was one influence, he speculates.

And then there was the day in his middle school science class when a substitute, as substitutes are wont to do, showed a film, this one on the discovery and rapid spread of the HIV virus. The movie had an indelible effect on Kobner—"The Wow! factor, as he puts it.

Whatever the influences, by high school Kobner had developed an interest in infectious disease. What propelled that attraction into an education and career plan, he says, was the Young Epidemiology Scholars (YES) Competition.

Now a biology major at Emory University in Atlanta, with plans to go to graduate school in medicine and public health, Kobner says of YES:

It really did shape where I was going to go [to college] and what I was going to do for the rest of my life.

YES: "The best and the brightest. YES was a competitive scholarship program aimed at encouraging talented high school students to investigate public health issues and ultimately pursue a career in the public health field. Epidemiology—the study of the causes, distribution and control of disease among populations—is the basic science of public health.

Initiated in 2003 by the Robert Wood Johnson Foundation (RWJF) and managed by the College Board, YES ran for eight years, attracting the participation of nearly 5,000 high school juniors and seniors—"the best and the brightest from across the country, in the words of RWJF Senior Program Officer Pamela G. Russo, MD, MPH.

YES contestants identified a health problem, gathered data about the problem, and proposed a solution based on what the data showed. Survivors of the initial review process presented their projects in person to expert judges from the health field at a three-day Washington conference.

When the annual competitions ended in 2011—a casualty of the nation's economic recession and a change in RWJF's grantmaking strategy in the public health area—a total of 976 YES participants had collected some $3.7 million in college scholarships, ranging from $1,000 for semifinalists to up to $50,000 for each year's top two winners.

But while the program is now over, its impact is not, as the story of Scott Kobner illustrates. Kobner's experience is one example of how YES could and did make a difference in young people's academic and career choices. It's also evidence of what Russo says is the program's lasting legacy:

YES is definitely going to influence who's going to be in the lead in public health in the next 10 years.

CA-MRSA: The focus. When Kobner got a postcard about the YES competition, he knew he wanted to enter. He also knew he wanted his project to deal with infectious disease and "have a tangible impact on the community I lived in.

But what disease, what kind of project? Kobner's school—Hunterdon Central Regional High in the central New Jersey borough of Flemington—did not have a research-oriented curriculum. So for the specifics, he was on his own.

His aunt had worked at Robert Wood Johnson University Hospital in New Brunswick and suggested that as a resource. He took her advice and emailed Arlene Potts, MPH, the hospital's director of infection prevention. "I thought I'd reach out to the top of the food chain in terms of infectious disease, he says.

Potts was happy to help and sent Kobner away from their first meeting with a stack of medical journals to look through for ideas. The article that got his attention was about a football player who died from the antibiotic-resistant bacteria MRSA (methicillin-resistant Staphylococcus aureus).

More specifically, it was CA-MRSA, for community acquired or associated—the designation for a MRSA infection in someone who has not recently been hospitalized or otherwise involved in a health care setting.

Traditionally most MRSA cases are associated with health care facilities and procedures—called HA-MRSA in those circumstances. But, as Kobner learned, CA-MRSA infection rates are on the increase, and people in close physical contact with others are at greatest risk. Athletes, he read, are one such group.

"I tried getting through a few more reports, but that football player's case kept drawing me back. I knew I'd found my research topic, Kobner wrote later in the Johns Hopkins University magazine Imagine. ("An Ounce of Prevention: Educating Athletes about MRSA. Imagine, January/February 2009. Available online.)

Looking in the locker room. Kobner implemented a MRSA research and prevention program for members of four of his school's sports teams: football, field hockey, and boys' and girls' soccer.

Why those four? Because, Kobner knew, the players wear padding and other equipment, which can be a medium for MRSA transmission. Thus members of these teams were at higher risk than members of, say, the cross-country running team, he reasoned.

With Potts as his project mentor, Kobner evaluated the athletes' hygiene habits and knowledge of CA-MRSA, and sought to raise both through education. His curriculum of short lectures and written handouts incorporated information from government health advisories and data on the correlation between infection risk and hygiene-related practices, including the importance of keeping equipment clean.

He also looked for the germs themselves. Using culturing supplies and training provided by Potts' hospital, Kobner collected bacterial samples from the players' equipment. No MRSA showed up, but he did find—as his Imagine article put it—"large amounts of staph on all their gear—especially in the players' equipment bags.

Outcomes: The project. To measure the effectiveness of the intervention, Kobner tested team members before and after and observed their hygiene-related behavior.

The results were, he readily concedes, disappointing. While the athletes registered an increased understanding of CA-MRSA's causes and effects, the knowledge did not translate into risk-reducing changes in behavior. Breaking players' habits would take a more intensive education program than he offered, Kobner concluded.

One result in particular surprised him. "I know plenty of male athletes in high school are real nasty in terms of hygiene, Kobner says. "But the female population I looked at was actually less responsive than the males were. A lot of their sharing practices, like razors and towels and equipment, made their situation far worse.

Outcomes: Beyond the project. Though the research findings were not what Kobner had expected, the overall YES experience far exceeded his hopes. Kobner was among the 12 top national finalists in the 2007–2008 YES competition, winning a $15,000 scholarship. Beyond the tangible monetary award, Kobner says just undertaking and completing the YES project was itself rewarding—learning about the research process, problem solving, and attending the Washington conference where the top 60 contenders presented their projects. Recalls Kobner:

Just being in a group of peers who are also so interested and passionate about the same thing is a very indescribable experience in terms of what it can do to get you excited—an excitement that lasts more than the weekend and possibly for the rest of your life.

In addition, Kobner and the two first-place YES winners also received a trip to Atlanta and a tour of the Centers for Disease Control and Prevention (CDC). For Kobner, who had just completed his junior year of high school, the trip was a definite factor in his decision to apply to Emory, he says. And the tour of the CDC also solidified a long-term goal: to join the CDC's Epidemic Intelligence Service.

The YES experience and excitement have definitely lasted into Kobner's undergraduate years at Emory, where his out-of-classroom activities include: